(1)  If an insurer has established a complaint resolution body or grievance appeal board, the body or board shall include at least one consumer representative.

Terms Used In Utah Code 31A-4-116

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Insurance: includes :
(i) a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;
(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and
(iii) a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301
(2)  Adverse benefit determination procedures for health insurance policies and health maintenance organization contracts shall be established in accordance Sections 31A-22-629 and 31A-22-650.

Amended by Chapter 439, 2019 General Session

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